Healthcare Provider Details

I. General information

NPI: 1376150987
Provider Name (Legal Business Name): MR. GERALD ADRIAN WRIGHT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 JENKINS ST
MEMPHIS TN
38118-5204
US

IV. Provider business mailing address

PO BOX 300185
MEMPHIS TN
38130-0185
US

V. Phone/Fax

Practice location:
  • Phone: 901-406-3670
  • Fax:
Mailing address:
  • Phone: 901-406-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number200008503
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: